Korean Journal of Nephrology 1999;18(4):560-569.

성인 급성 신부전 환자의 예후인자 분석 (Analysis of Risk Factors in the Patients with Acute Renal Failure)

유기동, 김영곤, 정종훈 (Ki Dong Yu, Young Gon Kim and Jong Hoon Chung)

Abstract

Background
Acute renal failure(ARF) is characterized by rapid decline in glomerular filtration rate and retension of nitrogenous waste products. This syndrome occurs in approximately 5 percent all hospital admissions and up to 30 percent of admissions to intensive care units. ARF is diagnosed when screening of hospital patients reveals a recent increase in serum BUN(blood urea nitrogen) and creatinine. The mortality rate for ARF is approximate 40-60% and has changed little in past three decades. This lack of improvement in outcome, despite significant advances in medicine. The reasons of high mortality rate is not certain. This study intend to identify prognostic risk factors influencing survivals. Methods:We retrospectively analyzed 60 patients with ARF during 2 years period from Oct. 1996 to Oct. 1998 at chosun university hospital. Multiple factors which may influence mortality were evaluated. Results: 1)Of the 60 patients, 34 were male and 26 were female. The mean age was 55.8±15.9 years. 2)The cause of ARF is Drug, toxin, dehydration, infection, trauma, surgery, urinary tract obstruction, HFRS, rhabdomyolysis and bleeding. 3)Underline disease is observed in 52 case. DM, Hypertension, Malignancy, Pulmonary disease, Liver disease, Renal disease 4)The mortality rate is 31.7%. The major cause of deaths is DIC, infection and hepatic failure. 5)Based on the unpaired t-test, chi-squre analysis, albumin, total bilirubin, hemoglobin, thrombocytopenia, APACHE Ⅱ score, serum sodium, urine creatinine, number of multiple organ failure, cause of acute renal failure, pH, vital sign on admission, sepsis, DIC, oilguria, and hemodialysis were significant factors between survivors and nonsurvivors(p< 0.05). 6)APACHE Ⅱ score on admission is good prognostic factor for patients with acute renal failure (p<0.001). Conclusion:This results suggest that the evaluation of patients symptom, sign, laboratory data, APACHE Ⅱ score is important for patients with acute renal failure. the discriminant score by multiple analysis and APACHE Ⅱ score could relatively predict the mortality of ARF patients. however further evaluation and clinical apply of prognostic factors is required to confirm these results.